Classification
A number of different classification systems exist. The traditional system divided burns in first-, second-, or third-degree.
[6] This system is however being replaced by one reflecting the need for surgical intervention. The burn depths are described as either superficial, superficial partial-thickness, deep partial-thickness, or full-thickness.
[7]
The following are brief descriptions of these classes:
[edit] By degree
Three degrees of burns
- First-degree burns are usually limited to redness (erythema), a white plaque and minor pain at the site of injury. These burns involve only the epidermis. Most sunburns can be included as first-degree burns.
- Second-degree burns manifest as erythema with superficial blistering of the skin, and can involve more or less pain depending on the level of nerve involvement. Second-degree burns involve the superficial (papillary) dermis and may also involve the deep (reticular) dermis layer. Deep dermal burns usually take more than three weeks to heal and should be seen by a surgeon familiar with burn care, as in some cases severe hypertrophic scarring can result. Burns that require more than three weeks to heal are often excised and skin grafted for best result.
- Third-degree burns occur when the epidermis is lost with damage to the subcutaneous tissue. Burn victims will exhibit charring and extreme damage of the epidermis, and sometimes hard eschar will be present. Third-degree burns result in scarring and victims will also exhibit the loss of hair shafts and keratin. These burns may require grafting. These burns are not painful, as all the nerves have been damaged by the burn and are not sending pain signals; however, all third-degree burns are surrounded by first and second-degree burns, which are painful.
- Fourth-degree burns occur when heat damage destroys the dermis and muscle is affected. Like third-degree burns, fourth degree burns result in scarring and the loss of hair shafts; skin grafting will be needed and permanent motor damage may occur.
- Fifth-degree burns occur when all the skin and subcutaneous tissues are destroyed, exposing muscle. These burns can be fatal due to breaches of major arteries and veins. These burns also may require amputation due to damage to muscles. If amputation is not needed, skin grafting will be needed, and permanent and prominent scarring with loss of keratin and hair shafts in the area of the burn.
- Sixth-degree burns occur when heat destroys the muscles, charring and exposing the bone. These burns are almost always fatal, and if death does not occur, amputation will be required.
Other classifications
A newer classification of "Superficial Thickness", "Partial Thickness" (which is divided into superficial and deep categories) and "Full Thickness" relates more precisely to the epidermis, dermis and subcutaneous layers of skin and is used to guide treatment and predict outcome.
A description of the traditional and current classifications of burns.
Nomenclature Traditional nomenclature Depth Clinical findings Example Superficial thickness first degree Epidermis involvement
Erythema, significant pain, lack of blisters
Partial thickness – superficial second degree Superficial (papillary)
dermis Blisters, clear fluid, and pain
Partial thickness – deep second degree Deep (reticular) dermis Whiter appearance or fixed red staining (no blanching), reduced sensation
Full thickness third degree Epidermis, Dermis, and complete destruction to subcutaneous fat, eschar formation and minimal pain, requires skin grafts Charred or leathery, thrombosed blood vessels, insensate
We can´t even image pain and horror of her family neither hers during this war. I have read stories from many my friends from Gaza at war when they had seen what cause white phosphorous and then saw it coming from sky.
